Basic Information
| Provider Information | |||||||||
| NPI: | 1245258011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOGER | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1820 PRESTON PARK BLVD | ||||||||
| Address2: | 1825 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750933656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728677862 | ||||||||
| FaxNumber: | 9726121623 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725966800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101239154 | VA | N | Other Service Providers | Specialist | 2085R0202X | M8847 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 195493503 | 05 | TX | MEDICAID | TXB107478 | 01 | TX | MEDICARE PTAN | OTHER | 8K7783 | 01 | TX | MEDICARE PTAN | OTHER | 195493501 | 05 | TX | MEDICAID | 195493502 | 05 | TX | MEDICAID | 8K6553 | 01 | TX | MEDICARE PTAN | OTHER |